Roundup of selected state health developments, first-quarter 2023 

May 19, 2023

Statehouses across the United States stayed busy in the first quarter of 2023, tackling issues like leave, health insurance and prescription drug pricing. New laws in Arkansas and Tennessee allow for family leave insurance. Illinois now requires all workers to earn paid leave they can use for any reason, starting in 2024. A recent San Francisco ordinance institutes paid military leave, while changes to existing paid leave laws occurred in Puerto Rico and two Minnesota cities. A new Seattle ordinance provides paid sick and safe leave benefits to gig workers. COVID-19 leave mandates expired in several California localities. Telehealth access gained traction in several states, including Idaho, Utah, Vermont, Washington and Wyoming. More than a half dozen states passed prescription drug laws, including ones capping insulin cost sharing in Washington and West Virginia. Illinois and New York were among states issuing insurance coverage mandates. North Carolina expanded its Medicaid program, as allowed under the Affordable Care Act (ACA).

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Six states are still considering paid family and medical leave (PFML) bills during the 2023 legislative session: Florida, Louisiana, Missouri, Minnesota, Nebraska and North Carolina. Illinois enacted a new law requiring almost all employers in the state to provide paid leave that employees can use for any reason. Arkansas and Tennessee passed optional family leave insurance laws similar to one enacted last year in Virginia. Colorado and Massachusetts made minor changes to existing paid leave laws. San Francisco’s paid military leave mandate is now in effect. A few California local COVID-19 leave mandates have ended. Seattle added a paid sick leave mandate for certain employers. Puerto Rico’s paid vacation and sick leave law has reverted back to pre-July 2022 standards because of a court ruling. Two Minnesota cities amended their paid sick leave ordinances.

Several states are considering how to enhance telehealth capabilities and access. Recent laws in Idaho, Utah and Wyoming enable out-of-state providers to offer services more easily to state residents. Vermont and Washington have extended key deadlines whose expiration would have restricted telehealth use.

Prescription drug costs are a high priority for many state legislatures in 2023. In particular, insulin affordability is a key concern; Washington and West Virginia have passed laws capping participants’ out-of-pocket costs for insulin. Other states may follow suit in the absence of broad federal legislation (other than Medicare’s cap) on this issue. Arkansas focused on rebates and insured plans issued in other states. New laws in South Dakota and Wyoming restrict pharmacy benefit manager (PBM) activities, while Indiana has issued regulations implementing a significant 2020 PBM law. Virginia now requires a real-time online preauthorization process for prescriptions that provides information about patient out-of-pocket costs and alternative medications.

More states are looking at HIV-related drug coverage mandates; Illinois and New York enacted laws in this area (as well as other insurance coverage requirements). Virginia passed laws on continuity of care and multiple employer welfare arrangements (MEWAs). The state also issued regulations on association health plans (AHPs), a type of multiple-employer welfare arrangement (MEWA). New Mexico and West Virginia enacted laws that clarify insurance issues for MEWAs and high-deductible health plans (HDHPs).

New Jersey’s new pay equity law requires employers to offer comparable pay and benefits to temporary employees. North Carolina expanded Medicaid eligibility. New York and San Francisco recently updated information related to annual reporting requirements. Virginia passed an unpaid organ donation leave law. Washington provided updated PFML and long-term care (LTC) resources.

• Illinois requires paid leave for any reason starting in 2024 (April 11, 2023)
• Roundup of selected state health developments, fourth-quarter 2022 (Feb. 17, 2023)
• States, cities tackle COVID-19 paid leave (Feb. 15, 2023)
• New York announces 2023 HCRA covered-lives assessment rates (Jan. 24, 2023)
• Roundup of selected state health developments, second-quarter 2022 (Aug. 22, 2022)
• Roundup of selected state health developments, first-quarter 2022 (May 31, 2022)

• Texas judge pares back ACA preventive services coverage requirement (March 31, 2023)
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